[Hiring] Pharmacy Audit Analyst @UnitedHealth Group

Role Description

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best.

Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale.

Schedule:

• Monday through Friday with 8-hour shifts between the hours of 6am-5pm PST
• Flexibility to telecommute from anywhere within the U.S.

Primary Responsibilities:

• Identify and document fraudulent or erroneous activities determined as a result of an audit
• Prepare audit reports and determine overpayments
• Amends audit reports and determines overpayments
• Collaborates with Claims Administration in the reverse and re-billing of overpaid claims
• Coordination of timely closure of audits
• Reviews and analyzes claims data, applying knowledge of pharmacy policy/practice and data mining techniques to determine details of overpayment billing activity while assisting with oversight of various audit programs
• Monitors and reports accordingly any compliance issues with regulatory requirement

Qualifications

• Active and unrestricted Pharmacy Technician license in the state of residence
• Active National Certification by the PTCB (Pharmacy Technician Certification Board)
• 2+ years of experience working in pharmacy audit, PBM, healthcare investigations, or health insurance environment
• 2+ years of experience in a position processing/auditing pharmacy claims
• Intermediate level of proficiency with Microsoft Excel
• Ability to work an 8-hour shift, Monday - Friday, between the hours of 6 am-5 pm PST
• Ability to train Monday – Friday from 8 AM – 5 PM PST
• Must be 18 years of age OR older

Requirements

• In-depth knowledge of pharmacy operations
• *All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.

Benefits

• Paid Time Off which you start to accrue with your first pay period plus 8 Paid Holidays
• Medical Plan options along with participation in a Health Spending Account or a Health Saving account
• Dental, Vision, Life & AD&D Insurance along with Short-term disability and Long-Term Disability coverage
• 401(k) Savings Plan, Employee Stock Purchase Plan
• Education Reimbursement
• Employee Discounts
• Employee Assistance Program
• Employee Referral Bonus Program
• Voluntary Benefits (pet insurance, legal insurance, LTC Insurance, etc.)

You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear directions on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Company Description

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone–of every race, gender, sexuality, age, location, and income–deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups, and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes — an enterprise priority reflected in our mission.

UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.